Atrial fibrillation is one of the most common arrhythmia. Cardiac mapping technology, an important method to study the electrophysiological mechanism of atrial fibrillation, can determine the abnormal origin and record the distribution and transmission way of these atrial electrical signals. This technology offers a new way for research the electrophysiological mechanism of atrial fibrillation. The purpose of this study is to review the research progress of cardiac mapping in the electrophysiological mechanism of atrial fibrillation and clinical application.
Atrial fibrillation (AF) is one of the most common arrhythmias. Today, there are a large number of AF patients worldwide, and incidence increases with the increase of age. However, the current diagnosis rate of AF via auxiliary examination is relatively low. In view of the widespread application of artificial intelligence (AI) in the medical field, the diagnosis of AF using AI has also become a research hotspot. This article briefly introduces the relevant aspects of AI and reviews the application of AI in AF prediction.
ObjectiveTo assess the safety of the removal of pericardial and mediastinal drain within different drainage volume after cardiac valvular replacement surgery.MethodsBetween July 2013 and July 2017, 201 patients with rheumatic heart disease (CHD) were treated with valve replacement in our hospital, including 57 males and 144 females, aged 15 to 72 years. They were divided into two groups according to the amount of 24-h drainage before the drain removal: a group one with 24-h drainage volume≤50 ml (n=127) and a group two with 24-h drainage volume>50 ml (n=74). The postoperative hospital stay and the incidence of severe complications between the two groups were compared.ResultsThere was no difference between the two groups in the baseline information or the incidence of severe pericardial effusion and tamponade, while the group two tended to have a shorter length of hospital stay after surgery (8.0 d vs. 7.5 d, P=0.013).ConclusionIn CHD patients undergoing valvular surgery, compared with a relatively low amount of drainage before the drain removal, drawing the tube at a greater amount of drainage (24-h drainage volume>50 ml) will shorten the length of hospital stay after cardiac surgery while incidence of severe complications remains the same.
Atrial fibrillation is a common arrhythmia associated with high mortality and morbidity, and the current treatment of atrial fibrillation is still limited. Histone deacetylase (HDAC) plays an important role in the pathophysiology of cardiovascular disease and promotes the occurrence of atrial fibrillation. Inhibition of HDAC may be a new therapeutic strategy through the regulation of atrial remodeling. Therefore, we reviewed the research progress of the HDAC and atrial fibrillation.
Atrial fibrillation is now the most frequent kind of adult arrhythmia in the world, with a prevalence rate at 2%-4%. In addition to the clinical symptoms of palpitation, shortness of breath, chest tightness, and decreased exercise tolerance, patients with atrial fibrillation have a 4 to 5 times higher risk of ischemic stroke than patients without atrial fibrillation, so anticoagulation therapy should be tailored to the CHA2DS2-VASc [congestive heart failure, hypertension, age≥75 years (doubled), diabetes mellitus, stroke (doubled)-vascular disease, age 65-74 years and sex category (female)] score. Oral anticoagulants not only prevent thrombosis, but also raise the risk of drug-related bleeding. This paper examines the assessment and mitigation of bleeding risk in atrial fibrillation and venous thromboembolism: A position paper from ESC/EHRA/AACA/APHRS, in order to provide readers with the most up-to-date research on anticoagulant bleeding risk management in patients with atrial fibrillation.
Radical surgical resection is still the only potentially curative treatment for pancreatic cancer. With the update of minimally invasive concepts, the laparoscopic and robotic platform has been introduced to pancreatic surgery practice. The recent studies have demonstrated that minimally invasive procedure achieved similar or improved perioperative outcomes compared to the standard open approach. Neo-adjuvant chemotherapy is increasingly being applied in pancreatic surgery, making surgical resection more challenging. Numbers of patients undergoing minimally invasive resection following neo-adjuvant chemotherapy remain low. The author consulted the latest literatures at home and abroad and described the current situation of minimally invasive treatment of pancreatic cancer after neo-adjuvant chemotherapy.
Objective To evaluate the effect of the 3D-printed heart model on congenital heart disease (CHD) education through systematic review and meta-analysis. Methods The literature about the application of the 3D-printed heart model in CHD education was systematically searched by computer from PubMed, Web of Science, and EMbase from inception to November 10, 2022. The two researchers independently screened the literature, extracted data and evaluated the quality of the literature. Cochrane literature evaluation standard was used to evaluate the quality of randomized controlled trials, and JBI evaluation scale was used for cross-sectional and cohort studies. ResultsAfter screening, 23 literatures were included, including 7 randomized controlled trials, 15 cross-sectional studies and 1 cohort study. Randomized controlled trials were all at low-risk, cross-sectional studies and and the cohort study had potential bias. There were 4 literatures comparing 3D printing heart model with 2D image teaching and the meta-analysis result showed that the effect of 3D printing heart model on theoretical achievement was more significant compared with 2D image teaching (SMD=0.31, 95%CI –0.28 to 0.91, P=0.05). Conclusion The application of the 3D-printed heart model in CHD education can be beneficial. But more randomized controlled trials are still needed to verify this result.
Central venous stenosis is a common complication following long-term dialysis catheter placement in dialysis patients. Generally, percutaneous angioplasty is the treatment of choice, and venous stent implantation should be considered in different situations. However, the venous stent migrating into right atrium is a rare but fatal complication. We presented a patient whose superior vena cava stents migrated into right atrium, resulting in acute tamponade, and exploratory thoracotomy was proceeded.
Objective To investigate the vaccination rate of Coronavirus Disease 2019 (COVID-19) vaccine in patients undergoing cardiac mechanical valve replacement and to evaluate its effect on international normalized ratio (INR) value. MethodsWe investigated 132 patients who had received cardiac mechanical valve replacement and followed up in the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from May to October 2021. There were 51 males and 81 females aged 26-72 (53.01±9.51) years. ResultsThe vaccination coverage rate was 53.8%. Among the 61 unvaccinated patients, concerns about heart side-effects were the main reason. The average INR of the first review after vaccination was higher than that of the last review before vaccination, with a difference of 0.40±0.72 (P<0.001). ConclusionThe vaccination rate of patients after cardiac mechanical valve replacement is low. At the same time, COVID-19 vaccine may increase INR value, and it is suggested that patients should increase the frequency of review and adjust warfarin dosage after vaccination.
Objective To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.?Methods?We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010. According to the presence of preoperative death, all the patients were divided into two groups, 9 patients in the preoperative sudden death （PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years；43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years. Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.?Results?Univariate analysis result showed 7 candidate variables：body mass index （BMI, Wald χ2=2.150, P=0.143）, time of onset （Wald χ2=2.711, P= 0.100）, total cholesterol （TC, Wald χ2=1.444, P=0.230）, low density lipoprotein cholesterol （L-C, Wald χ2=1.341, P=0.247）, aortic insufficiency （AI, Wald χ2=2.093, P=0.148）, aortic sinus involvement （Wald χ2=3.386, P=0.066）and false lumen thrombosis （Wald χ2=7.743, P=0.005）. Multivariate logistic regression analysis showed that BMI （Wald χ2=4.215, P=0.040, OR=1.558）and aortic sinus involvement （Wald χ2=4.592, P=0.032, OR=171.166 ）were preoperative risk factors for sudden death, and thrombosed false lumen （Wald χ2=5.097, P=0.024, OR=0.011）was preoperative protective factor for sudden death.?Conclusion?Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.